Elevated blood pressure is such a common dilemma, and since we obtain blood pressure results every single time we do vital signs,

it is a very common dilemma that we have to deal with, both in the hospital and also in the outpatient setting,

and it's always changing a little bit in both settings. Meaning, if you look at the outpatient setting,

there was a little bit of a stir from this European

Heart Journal study in 2019. It was titled, Bedtime Hypertension Treatment Improves

Cardiovascular Risk Reduction. And in that trial, when you looked at sex, whether they're

male or female, age, or their entry- level blood pressure results. The results of the trial

showed that if you took blood pressure lowering drugs at bedtime instead of the morning, it reduced

cardiovascular events for all those people. And that was actually true across blood pressure

lowering classes, so five blood pressure lowering classes like ARBs and

antiotensin converting enzyme inhibitors, calcium channel blockers, beta blockers, diuretics.

In very few patients in the outpatient setting that I see take blood pressure medication at

bedtime. They're prescribed to take it in the morning. And that seems doubly true in the hospital.

I don't see many people being prescribed blood pressure medication at night in any of the hospitals

that I've worked at. Unless maybe it's a BID medication and, you know, occasionally, I guess I come

across people that take all their medicines at night, but it's not the norm. Now, some classes of medications, I think,

would be pretty hard to take at night like diuretics. Other classes RBID drugs, like Quantidine, for

instance. But on the typical daily medications, I guess we should maybe saying they should be

nightly medications, and we'll see if further trials show that to be true.

Now, before we dive into severe hypertension, I think it's important to remember that blood pressure is a balance, right?

We know that if it's too low, you have a problem.

If it's too high, you have a problem.

...